Studies urged of link between heart disease, sleep apnea

Monday

Two major heart groups called Monday for large-scale medical studies to determine the link between heart disease and the different forms of sleep apnea.

Two major heart groups called Monday for large-scale medical studies to determine the link between heart disease and the different forms of sleep apnea.

Prairie Heart Institute at St. John’s Hospital has been screening for sleep apnea in all its patients.

“Over the past three or four years, we’ve been asking every patient if they have sleep problems,” said Claire Call, heart failure coordinator at Prairie Heart.

More than 60 percent have some form of sleep-disordered breathing, she said.

“Maybe not full-blown sleep apnea, but they’re on their way there,” Call said. “You have to ask the question with their spouse or significant other in the room. The patients may think they’re sleeping, but the spouses can tell stories about even thin people.”

The American Heart Association and the American College of Cardiology published online a joint statement Monday asking for studies to determine the relationship between sleep apnea and heart disease.

Dr. Virend Somers, professor of medicine and cardiovascular diseases at the Mayo Clinic in Rochester, Minn., and chairman of the joint statement-writing committee, said there have been a number of studies on sleep apnea in the last decade, and those looking at cardiovascular diseases and their associations with sleep apnea are especially compelling.

“We feel it is important to alert the cardiovascular community to the implications of this emerging area of research,” he said. “It is possible that diagnosing and treating sleep apnea may prove to be an important opportunity to advance our efforts at preventing and treating heart disease.”

Obesity is a major cause of sleep apnea, “but it is more than that, too,” said Call, a registered nurse. She said sleep apnea is one of the most under-diagnosed medical problems.

Somers warned that sleep apnea cases are expected to increase due to “the current epidemics” of obesity, high blood pressure, atrial fibrillation and heart failure in the United States.

Call said pediatricians will have to look for sleep apnea, too, because of the increase in childhood obesity.

She said that for patients diagnosed with sleep apnea who can tolerate a continuous positive airway pressure (CPAP) mask, Prairie Heart has had “some amazing results with people reporting improved energy and alertness, less fluid retention and less shortness of breath.”

Other treatment alternatives, including a dental device that keeps the airway open, also are available in Springfield, she said.

If a Prairie Heart patient with heart failure screens positive for sleep apnea, they are referred to the sleep disorder team for an outpatient sleep study, she said.

She cited the case of one patient who had hypertension, but didn’t want to go for sleep studies.

“We basically badgered him into going,” she said. “When he was done, he called and said he hadn’t slept that well since grade school. Now he wants to do things with his family and play with his kids. He has more energy and is losing weight.”

She said patients with hard-to-manage hypertension who already are on three classes of medication to treat it especially need a sleep study to test for sleep apnea. She said sleep apnea could be the cause of the hypertension, and once treated, their medications may be decreased.

Call said Prairie Heart wants to be able to start doing sleep studies at the patient’s home, where surroundings are more familiar and conducive to sleep. She said they’re trying to get Medicare to pay for such in-home studies.

“For now, until we have more clear information as to who should be treated and what the benefits of treatment should be, patients should be assessed on an individual basis,” Somers said.

“Until we know the cause-and-effect relationship between sleep apnea and cardiovascular disease, it would be best to take a two-pronged approach and treat patients from both perspectives: In other words, treat both their sleep apnea and their cardiovascular disease.”

Chris Dettro can be reached at (217) 788-1510 or chris.dettro@sj-r.com.

Symptoms of sleep apnea, which according to the National Institutes of Health affects more than 12 million Americans, may include:

-- Excessive daytime tiredness

-- Problems with energy

-- Shortness of breath

-- Waking with an unrefreshed feeling after sleep

-- Memory and concentration problems

-- Morning or night headaches

-- Heartburn or a sour taste in the mouth at night

-- Getting up during the night to urinate

-- Sweating and chest pain while sleeping

Others may notice episodes of not breathing, loud snoring or restless tossing and turning during sleep.

A continuous positive airway pressure (CPAP) machine is used by patients for the treatment of sleep apnea at home.

Obstructive sleep apnea occurs when the upper airway is blocked. This reduces oxygen in the blood and causes arousal from sleep. The CPAP machine delivers a stream of compressed air via a hose to a mask, keeping the airway open under air pressure.

It also may reduce or eliminate the extremely loud snoring that sometimes accompanies sleep apnea.

Central sleep apnea results when the brain reduces the drive to breathe.

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